9mm nodule

[KBird01]

Hi everyone. I posted around 4 months ago having had ongoing issues with many symptoms, including fatigue, brain fog, etc. etc. I do not have a thyroid diagnosis, so am on no medication for this.

Due to my feeling a pressure on my throat when I lay down, along with other tests I also had a thyroid scan. This has shown a 9mm nodule on my right thyroid lobe. The GP says this was seen by the consultant radiographer, is benign and isn't likely to be the cause of the problem. They don't think this is anything to worry about. Just checking in as ever, with you all for your thoughts.

Here are my latest thyroid check results. All done before 9am.

Feb 23 - GP Test

Serum TSH level - 1.91 miu/L [0.34-5.6]

Jan 23 - Medichecks

Serum TSH level - 2.18 mU/L [0.27 - 4.2]

Free T3 - 3.81 pmol/L [3.1 - 6.8]

Free Thyroxine - 14.3 pmol/L [12 - 22]

I guess a couple of questions I have are:

1. Could this nodule be the cause of my fatigue, etc?

2. How do they know it's 'benign'?

Thanks as ever for any info/advice you can offer. 😊

[PurpleNails Administrator]

Q) Could this nodule be the cause of my fatigue, etc?

A) My guess is no - (to nodule itself) but yes to thyroid.  Even if nodule is “cold” ie non function the remaining thyroid would / should function sufficiently. 

 Nodules are extremely common & almost considered normal part of aging. 

Q) How do they know it's 'benign'?

A) Under 1cm is often considered not significant.  When scanning with ultrasound the image will often show often features eg Vascularity / calcification.  There is a grading level & if flagged a fine needles aspiration is performed.  

Did drs have any explanation why the feeling compression? 

Contact the department arranging the scan & request a copy of scan report.  There are often technical details which are not explained.  I’ve also had members report back that the report highlights follow up is required but doctor has not arranged.  

Bear in mind an ultrasound does not determine function throughout the thyroid, the scan can looks a size & health of thyroid.   So in theory the nodule could be the only area functioning and the rest of thyroid is non function or vice versa.  

What should show is if thyroid levels are low the TSH should rise & your TSH is in range.  Are nutrients optimal? Low nutrient can keep TSH low, optimal nutrient can help TSH reflect low levels.

Testing of thyroid levels is reliant on blood tests. So most never know what areas of thyroid functions.

 Your thyroid levels show the FT4 & FT3 are quite low.  Your antibodies have not been positive so next step it to monitor FT4 & FT3 as if they decline further you will need hormone replacement. 

Next steps:

Copy of scan report

Monitor thyroid function levels

Ensure nutrients are optimal

[SlowDragon Administrator]

Results from 4 months ago

healthunlocked.com/thyroidu...

Low ferritin

Low vitamin D

As vegetarian you need full iron panel test before considering iron supplements

Did you get that done

Are you now taking higher dose vitamin D

and separate magnesium supplement

Are you on gluten free or dairy free diet

Suggest you get FULL Thyroid and vitamin testing redone

Medichecks Thyroid plus antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins

bluehorizonbloodtests.co.uk...

If you can get GP to test vitamins then cheapest option for just TSH, FT4 and FT3 and includes BOTH TPO and TG antibodies -£29 

randoxhealth.com/at-home/Th...

Monitor My Health also now offer thyroid and vitamin testing, plus cholesterol and HBA1C for £65 

(Doesn’t include thyroid antibodies) 

monitormyhealth.org.uk/full...

10% off code here 

thyroiduk.org/getting-a-dia...

Only do private testing early Monday or Tuesday morning. 

[KBird01 in reply to SlowDragon]

Thanks for your reply SlowDragon .

Iron - yes, I had an iron panel done and this didn't indicate a reason not to commence iron supplements, so with a ferritin reading of 20's for years (I now have access to my GP records), I commenced gentle iron supplements, along with high dose D, B12 and A-Z vitamins. I saw improvements in fatigue, concentration, mood and also the 'lump in throat' feeling within 2-5 weeks.

I have had several negative results for coeliac disease but have just sent off for a food intolerance test and on the advice of my GP are planning on a gluten-free trial to see what happens. If nothing else, I feel things are pointing to some kind of absorption issue going on.

Thanks for the link re: testing. I usually use Medichecks, so it's good to know of alternatives. It's been a costly journey so far. My plan is to give things another month (giving me 12 weeks from starting supplementation), then do another set of tests to compare.

Thank you again for your info and advice. 😊

[SlowDragon Administrator in reply to KBird01]

cks.nice.org.uk/topics/anae...

Serum ferritin level is the biochemical test, which most reliably correlates with relative total body iron stores. In all people, a serum ferritin level of less than 30 micrograms/L confirms the diagnosis of iron deficiency.

Never supplement iron without doing full iron panel test for anaemia first and retest 3-4 times a year if self supplementing. It’s possible to have low ferritin but high iron 

Medichecks iron panel test 

medichecks.com/products/iro...

Look at increasing iron rich foods in diet 

daily orange juice or other vitamin C rich drink can help improve iron absorption

List of iron rich foods

dailyiron.net

Links about iron and ferritin

irondisorders.org/too-littl...

davidg170.sg-host.com/wp-co...

Great in-depth article on low ferritin 

oatext.com/iron-deficiency-...

drhedberg.com/ferritin-hypo...

This is interesting because I have noticed that many patients with Hashimoto’s disease and hypothyroidism, start to feel worse when their ferritin drops below 80 and usually there is hair loss when it drops below 50.

healthunlocked.com/thyroidu...

Effective supplement 

healthunlocked.com/thyroidu...

Thyroid disease is as much about optimising vitamins as thyroid hormones

healthunlocked.com/thyroidu...

restartmed.com/hypothyroidi...

Post discussing just how long it can take to raise low ferritin 

healthunlocked.com/thyroidu...

Iron and thyroid link

healthunlocked.com/thyroidu...

Excellent article on iron and thyroid 

cambridge.org/core/journals...

Posts discussing why important to do full iron panel test

healthunlocked.com/thyroidu...

Good iron but low ferritin 

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

Shellfish and Mussels are excellent source of iron 

healthline.com/nutrition/he...

Heme iron v non heme

hsph.harvard.edu/nutritions...

Ferritin over 100 to alleviate symptoms 

healthunlocked.com/thyroidu...

Great research article discussing similar…..ferritin over 100 often necessary 

ncbi.nlm.nih.gov/pmc/articl...

Low Iron implicated in hypothyroidism 

healthunlocked.com/thyroidu...

Ferritin range on Medichecks 

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

We have received further information the lab about ferritin reference ranges. They confirm that they are sex dependent up to the age of 60, then beyond the age of 60 the reference range is the same for both sexes: 

Males 16-60: 30-400 ug/L

Female's: 16-60: 30-150

Both >60: 30-650 

The lower limit of 30 ug/L is in accordance with the updated NICE guidance and the upper limits are in accordance with guidance from the Association of Clinical Biochemists. ‘

[KBird01 in reply to SlowDragon]

Thanks for all the links SlowDragon , that's really helpful. 😊

[Litatamon]

Hi,

PurpleNails has already explained the grading system that they do with nodules & how common they are, and the great advice to request the report. Besides pertinent information on the nodule itself, there will probably be a time suggestion of further screening.

For instance I had about five or six nodules but only two were an issue. And only two needed needle biopsies. Due to size (one almost 4 cm and the other 3.2 cm) & their vascularity and borders. Over 95% of all nodules are benign.

Your feeling in your throat could be silent reflux. I have had a thyroidectomy due to choking and breathing issues. And felt tremendous relief after surgery because two were placed too close to my windpipe and esophagus. But when they put the camera down to check on my vocal cords pre-surgery she told me I had an inflamed area which denotes silent reflux. And I can still feel that at times. And wheeze a bit still.

I did a physical test for the multinodular goitre. Lift your arms over your head and lower your chin to your chest. You should be able to talk and breathe with ease. That test stopped my breathing practically and any attempt to speak sounded like the devil. It was a good indicator. So give it a try, but I would guess that they would have screened for an unfavorable positioning of the nodule. Four centimetres is the usual cut off for action, besides a malignant module found by a needle biopsy. I hope you get this all figured out soon.

[KBird01 in reply to Litatamon]

Thanks for sharing Litatamon . I shall wait until no-one's watching to try the hands above my head manoever! I'll see what I can find out about whether there were any follow ups advised from the scan. I think you have a good point about the silent reflux. I'm just undergoing some food sensitivity tests, but do think there's some kind of digestive system thing going on too - or perhaps this is what has been at the bottom of it all... 😊